Tuesday, June 27, 2017

No! Treating gender dysphoria doesn't create gender dysphoria

Margot Cleveland

The Federalist is desperately in need of an editor to weed out some of the preposterously positioned polemics. Margot Cleveland should know better. She is well educated and an adjunct instructor at Notre Dame. On the other hand, she once wrote a piece titled “Why Practicing Catholics Definitely Have The Best Sex.” Definitely mind you. Tuesday's piece isn't any better. It is titled “Research Finds Parents Should Question Their Kids’ Gender Dysphoria Before It’s Too Late.” The subtitle reads:

It is one thing to compassionately treat those with gender dysphoria. It is another thing entirely to cause gender dysphoria.

This may be an abstraction for Ms. Cleveland. For children and their parents this is a reality that has to be properly addressed by the clinicians who work with these kids every day. The real professionals. There is no one at the Vatican with so much as a clue. People are advocating what amounts to child abuse based upon the pronouncements of a celibate theologian with no children (that we know of). The willful intellectual dishonesty is appalling.

On the heels of the Supreme Court’s 2015 decision in Obergefell v. Hodges, which declared a constitutional right to same-sex marriage, liberal activists quickly turned their gaze towards the “T” in LGBT. In just two short years, the transgender movement has morphed from a concern over discrimination and violence against those suffering from gender dysphoria to the normalizing and mainstreaming of the trans lifestyle.

Lili Elbe in 1926
Starting in 1930, Elbe had
four sex reassignment
surgeries over two years

This is a popular meme among religious conservatives. Activists are somehow creating trans children. The reality is that we have a better educated public (in spite of people like Ms. Cleveland). We also have better informed medical professionals and an accumulation of research. Together (parents and clinicians), they understand that a child with gender dysphoria is suffering and at a significant risk of suicide. Together they know that the earlier in life someone transitions, the happier and more successful they will be down the road. We have been studying this issue for nearly a century.

So, yes, there has probably been an increase in trans children due to better identification and care. That does not translate to an increase in children with gender dysphoria.

But Tuesday’s New Atlantis piece, “Growing Pains: Problems with Puberty Suppression in Treating Gender Dysphoria,” hopes to change the discourse—or lack thereof. In “Growing Pains,” co-authors Dr. Paul Hruz, Dr. Lawrence Mayer, and Dr. Paul R. McHugh provide the most comprehensive critique to date of the gender-affirming model of treatment for children suffering from gender dysphoria and expound on the many physical and psychological concerns that approach portends.

I said that this woman should know better. After all, to some extent she is an academic. A literature review is used to prove a point of view. It is not original science and — at least in this case – it is not peer-reviewed. Cleveland provides her own undoing:

… And parents of children either gender-confused or with gender dysphoria would be well-served to give serious thought to the meticulous and measured analysis in “Growing Pains,” which includes a review of over 50 peer-reviewed articles on gender dysphoria in children, and which led the authors to conclude that it does “not seem prudent to embrace hormonal treatments and sex reassignment as the foremost therapeutic tools for treating this condition.”

It is abundantly clear to those who have watched this develop that these people formed their views about trans kids well in advance of their literature review. At least one of the authors (Mayer) was an expert witness for the state in the North Carolina HB2 trial which preceded their review by at least a year. Their intent is to prove their religious precepts. Absent peer review they considered what amounts to 50 studies published over an unknown period of time that are cherry-picked to conform to their religious views. How many and which studies did they ignore? And of the studies that they used how much selective observation within the articles did they indulge in? Furthermore, how many of those articles were published to Linacre which is the journal of the Catholic Medical Association? We do not know and peer review in Linacre means testing for religious conformity in contrast to scientific soundness.

Furthermore, none of those men (including Dr. McHugh) have ever worked with gender dysphoric children. They lack the training and experience necessary for a scientifically valid review. Cleveland refers to gender confused children. What the hell does that even mean? Since she also mentions children with gender dysphoria, what is the difference between the two; confused vs. dysphoric?

But there is an even bigger take-away from “Growing Pains,” one which should concern all parents: “Gender identity for children is elastic (that is, it can change over time) and plastic (that is, it can be shaped by forces like parental approval and social conditions).”

This reality should give all parents pause: both the moms and dads who, to this point, have allowed their schools to preach the gospel of self-selecting gender—that boys can be girls and girls can be boys—and the parents whose sole objection, to date, has been the sharing of bathrooms and locker rooms. There is a much more serious threat in play than just student privacy. It is a matter of the psychological wellbeing of our children.

McHugh and company use a Dutch study to “prove” their point. First, the professional perspective from Dr. Jack Turban who is an expert in adolescent and pediatric gender dysphoria:

In a Dutch study of 55 transgender people who were given puberty blockers during adolescence, however, none changed their minds and none regretted treatment. All went onto cross-sex hormones around age 16 and later gender-affirming surgery. Psychological functioning improved steadily over the treatment period, and by the end, metrics of happiness and quality of life were on a par with those of the general population.

The McHugh crew has the temerity to claim that this proves that these people were molded into transgender people irrespective of the happiness and quality of life that they demonstrate. Were that the case, would these young people feel trapped in the wrong gender? Wouldn't they be suffering from induced gender dysphoria? So much for literature reviews that are not peer reviewed and used to conform science to scripture.

Dr. Turban, by the way, is a research fellow at the Yale School of Medicine. He has a BA in neurobiology from Harvard magna cum laude. MD, Yale. He is also a resident child and adolescent psychiatrist at The Massachusetts General Hospital & McLean Hospital in conjunction with Harvard Medical School. His research and writing are focused on child and adolescent psychiatry, with a concentration on pediatric gender identity. I don't know where he finds the time to pee.

It looks like she has given up on the pretense of gender dysphoria. They are all just confused:

We Need To Be Careful How We Shape Our Children

… when it comes to gender identity, children are plastic—that is, they “can be shaped by forces like parental approval and social conditions.” And gender confusion is a serious problem to thrust upon our youth: “[T]here is clear evidence that patients who identify as the opposite sex often suffer a great deal. They have higher rates of anxiety, depression, and even suicide than the general population.”

Who is more likely to be correct? Turban or Cleveland?

And the suggested treatment? Gender affirmation—even though, as “Growing Pains” explains, “most children who identify as the opposite sex will not persist in these feelings and will eventually come to identify as their biological sex.” For boys, the range of persistent gender dysphoria ranges from 2.2 percent to 30 percent, and for girls the range is 12 percent to 50 percent.

Except that is not true. Not even close. Furthermore the pediatric treatment is reversible puberty blockers which, of course, the McHugh crew claims are not reversible. As recently as ten years ago, “the hope was that early treatment would 'diminish the risk of a continuation of gender identity disorder into adulthood' — in other words, make children stop being transgender. Transgender youth during this time suffered high rates of depression and anxiety. By young adulthood, nearly half had attempted suicide.” In other words that proved to be the problem and not the solution. How much of the data that McHugh's group relied on is more than ten years old? We don't know. Imagine treating cancer based on papers published ten years ago.

The general medical consensus is that, by puberty, gender identity is fixed. Again, not for a second do I buy the boys' argument that we are creating trans people through gender affirmation who would otherwise not be trans. It is a persuasive argument to get people to ignore the real science. Persuasive bullshit.

It is one thing to compassionately treat those with gender dysphoria. It is another thing entirely to cause gender dysphoria. “Growing Pains” points to the real possibility that gender affirmation is not just a bad approach for treating gender dysphoria, but a bad approach for everyone else too. It’s time to stop silencing debate and have an honest discussion of all the risks. “For the sake of our children,” as the Left is prone to say.

I am still waiting to hear about the compassionate method for treating people with gender dysphoria. What exactly does that consist of? Where are the clinical papers in support? Or shall we just go backwards ten years and watch kids kill themselves? They will be dead but the Church will be defended. Fair deal, no?

We are talking about the welfare of children and these people want to conform to the advice of Vatican eunuchs who have no training or experience and refer to the medical science as "gender ideology." It is hard to imagine anything more morosely moronic. The bottom line is simple. If people follow their advice, children will die and that is not an exaggeration (I wish it were). My advocacy is what it is but these religious crackpots make me awfully fucking stubborn.